Gaba Saurabh, Gaba Nayana, Gupta Monica, Sharma Sanjana
General Medicine, Government Medical College and Hospital, Chandigarh, IND.
Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND.
Cureus. 2020 May 2;12(5):e7925. doi: 10.7759/cureus.7925.
Introduction Scrub typhus is a resurging zoonotic infection prevalent in South Asia with many recent outbreaks in India. It can mimic other tropical infections and the disease spectrum ranges from subclinical illness to life-threatening disease with multiorgan dysfunction. This study was conducted to study the pattern of hepatic and renal injury. Methods A retrospective study was done on 176 patients diagnosed by detecting IgM antibodies using an enzyme-linked immunosorbent assay (ELISA) over a period of three years at a tertiary center in Chandigarh, India. They were treated with doxycycline (azithromycin if pregnant) and supportive therapies. The patterns of hepatic and renal functions, along with the need of renal replacement therapy, were recorded and evaluated. The values were expressed as mean ± SD, and p values were calculated to establish statistical significance. Results Most of the cases were from the state of Haryana (37.5%), followed by Punjab (33.5%), Himachal Pradesh (13.6%), Uttar Pradesh (10.2%) and Chandigarh (5%). 30% of the study population was engaged in agriculture. The mean age was 32.3 ± 13.5 years with range of 13-65 years. A peak in the incidence was observed during monsoon months. Approximately 13% of the patients died. Urea, creatinine, bilirubin and aspartate transaminase were found to be higher in mortality group with statistical significance (p < 0.05). Alanine transaminase was higher and albumin was lower in the mortality group but without statistical significance. 27.8% had acute kidney injury, 90.9% had liver dysfunction and one patient had acute liver failure. All the pregnant patients had fetal loss. Conclusion Renal and liver dysfunctions are common in scrub typhus, and their occurrence adversely affects the outcome.
引言 恙虫病是一种在南亚再度流行的人畜共患感染病，印度近期有多次疫情爆发。它可类似其他热带感染病，疾病谱涵盖从亚临床疾病到伴有多器官功能障碍的危及生命的疾病。本研究旨在探讨肝损伤和肾损伤的模式。
方法 对印度昌迪加尔一家三级中心在三年期间通过酶联免疫吸附测定（ELISA）检测 IgM 抗体确诊的 176 例患者进行回顾性研究。他们接受了多西环素治疗（孕妇用阿奇霉素）及支持性治疗。记录并评估肝功能和肾功能模式以及肾脏替代治疗的需求。数值以均值±标准差表示，并计算 p 值以确定统计学意义。
结果 大多数病例来自哈里亚纳邦（37.5%），其次是旁遮普邦（33.5%）、喜马偕尔邦（13.6%）、北方邦（10.2%）和昌迪加尔（5%）。30%的研究人群从事农业。平均年龄为 32.3±13.5 岁，年龄范围为 13 - 65 岁。在季风月份观察到发病率高峰。约 13%的患者死亡。发现尿素、肌酐、胆红素和天冬氨酸转氨酶在死亡组中更高，具有统计学意义（p < 0.05）。丙氨酸转氨酶在死亡组中更高，白蛋白更低，但无统计学意义。27.8%有急性肾损伤，90.9%有肝功能障碍，1 例患者有急性肝衰竭。所有孕妇均发生胎儿丢失。
结论 恙虫病中肾和肝功能障碍很常见，它们的发生对预后有不利影响。
